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Empyema Thoracis in Sub-Saharan Africa

Empyema Thoracis in Sub-Saharan Africa

Patient details
Patient details
- Name: I.K - Age: 48 - Gender: Male - Location: Rural area in Kenya - Occupation: Farmer - Medical History: History of untreated pneumonia six weeks ago
Patient case fields
Presenting Complaint

I.K, a 48-year-old male farmer, presents to the local clinic with complaints of persistent fever, productive cough with purulent sputum, and pleuritic chest pain over the past two weeks.

 

 

 

History of Present Illness

I.K developed a severe cough with yellow-greenish sputum production following a bout of untreated pneumonia six weeks ago. He noticed increasing shortness of breath, especially with exertion, and pleuritic chest pain localized to the right side. He denies any recent trauma, haemoptysis, or weight loss.

Social and Environmental History

I.K lives in a rural village with his wife and three children. He works as a farmer, primarily cultivating maize and beans. Access to healthcare services is limited in his area, with the local clinic being the primary point of medical care.

Physical Examination

- General: Appears ill and fatigued

- Vitals: BP 130/80 mmHg, HR 100 bpm, RR 24 breaths/min, SpO2 92% on room air, temperature 38.5°C

- Respiratory: Decreased breath sounds and dullness to percussion over the right lower lung fields

- Cardiovascular: Regular rhythm, no murmurs

- Abdomen: Soft, non-tender, no organomegaly

 

 

Diagnostic Workup

- Chest X-ray: Right-sided pleural effusion with consolidation

- Thoracentesis: Pleural fluid analysis reveals turbid fluid with high leukocyte count and low glucose level, consistent with empyema

- Blood Tests: Elevated white blood cell count, elevated inflammatory markers

 

Diagnosis

Empyema Thoracis secondary to untreated pneumonia

Management Plan
  1. Antibiotic Therapy: Initiation of broad-spectrum antibiotics (e.g., intravenous ampicillin-sulbactam or ceftriaxone with metronidazole) to cover aerobic and anaerobic organisms.
  2. Thoracic Drainage: Insertion of a chest tube for drainage of empyema fluid and pleural space irrigation.
  3. Pleural Fluid Management: Serial thoracentesis and monitoring of pleural fluid characteristics.
  4. Pain Management: Analgesics for relief of pleuritic chest pain.
  5. Nutritional Support: Adequate hydration and nutrition to support recovery.
  6. Patient Education: Counselling on the importance of completing antibiotic therapy, follow-up care, and prevention of future respiratory infections.

 

Prognosis

With prompt diagnosis and appropriate management, Ibrahim has a good prognosis for recovery from empyema thoracis. Regular monitoring and follow-up will be essential to ensure resolution of the infection and prevent complications.

This case illustrates the clinical presentation, diagnostic approach, and initial management considerations for empyema thoracis in a patient from a rural setting in sub-Saharan Africa.

Discussion
No data was found
Questions

A). Tuberculosis

B). Untreated pneumonia

C). Lung cancer

D). Asthma exacerbation

 

 

 

 

2. Which diagnostic test confirmed the presence of empyema in IK?

 

A). Echocardiogram

B). Chest X-ray showing pleural effusion

C). Urinalysis

D). Blood glucose test

3. What finding on the pleural fluid analysis was indicative of empyema in IK?

A). Clear fluid with low leukocyte count

B). Turbid fluid with high leukocyte count and low glucose

C). Blood-tinged fluid

D). High glucose level

4. What is the initial treatment of choice for IK's empyema thoracis?

A). Antifungal therapy

B). Surgical resection

C). Broad-spectrum antibiotics and chest tube drainage

D). Chemotherapy

Reveal answers

Answers

  1. B). Untreated pneumonia
  2. B). Chest X-ray showing pleural effusion
  3. B). Turbid fluid with high leukocyte count and low glucose
  4. C). Broad-spectrum antibiotics and chest tube drainage